Healthcare Provider Details

I. General information

NPI: 1215504840
Provider Name (Legal Business Name): JULIA R INGRAM LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2149 JOLLY RD STE 500
OKEMOS MI
48864-6028
US

IV. Provider business mailing address

2149 JOLLY RD STE 500
OKEMOS MI
48864-6028
US

V. Phone/Fax

Practice location:
  • Phone: 517-347-4645
  • Fax: 517-347-4644
Mailing address:
  • Phone: 517-347-4645
  • Fax: 517-347-4644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401224322
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: